Study to Analyse Patient Flow in Queensland Public Hospitals

This study will adopt a system-wide view to capture relationships and interactions between flow metrics to identify access issues and inform the design of interventions/solutions to improve patient flow at a system level. A system-wide approach covering prehospital and ED services offers the potential for improving patient flow at the ambulance/hospital interface. By integrating ambulance, ED and inpatient data, it is possible to identify blockages along the entire patient journey that have a flow-on effect on ED access. It is also possible to identify critical hospital and ambulance service levels when performance starts to degrade, suggesting where the system would benefit from revised strategies.

The project ‘Study on Patient Flow in Queensland’s public hospitals’ is conducted by a research team comprising experts from CSIRO, Queensland Health, UQ and QAS.

SARS-CoV2 infection and immunity in frontline hospital staff during the COVID-19 pandemic

Health workers are at increased risk of exposure and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The implications of healthcare worker infection are wide-reaching and impact not only the worker, but also have implications for nosocomial spread in the pre-symptomatic phase and depletion of the skilled workforce required to manage an increased volume of presentations.

Front-line health care workers represent a unique cohort to follow for trends in SARS-CoV-2 infection, immune response and antibody production as well as monitoring for re-infection. Understanding the implications of staff infection on the potential for long-lasting immunity is of key significance to staff and leaders of EDs. Equally, understanding of asymptomatic staff infection can inform policy regarding routine screening of staff to minimise the risk of nosocomial spread to other staff and patients.

Implementation of Nasal High Flow: A Remote Context

In this study, the clinician-researchers are exploring whether nasal high flow (NHF) therapy can be safely and effectively used to improve health outcomes for infants with bronchiolitis in isolated remote communities, in particular for remote Indigenous Australians who have a higher incidence rate of bronchiolitis than non-Indigenous Australians. There is a desire by clinicians to implement NHF in remote areas, but this should undergo similar scientific scrutiny as previous published data.

NHF is a respiratory support system that provides support for people with respiratory conditions and is applied by high flow oxygen through nasal prongs. The therapy can avoid an escalation of care during hospitalisation. The safety of NHF has been widely studied in tertiary areas and regional hospitals, however, there is a lack of evidence to support safe use in remote settings.

In this study, the researchers are employing a two-phased approach: Firstly, an expert working party establishing agreed safe clinical boundaries for the NHF implementation and utilising expert viewpoints for implementation when managing infants with bronchiolitis. Secondly, a comparison of the outcomes before and after implementation to observe a reduction in escalation of care leading to reduced transfers. A community engagement process, with the focus to keep community members in their country/home environment, will be established to measure psychological, social-emotional and economic benefits of NHF.

Improving blood culture collections in the emergency department

The primary aim of this study is to assess the effectiveness of an intervention designed to improve the quality of blood cultures collected in a busy emergency department.

Blood cultures are tests that are frequently ordered by emergency doctors to detect and identify bacteria present in the blood of patients who are unwell. The test requires a sample of blood to be collected from the patient. Like many tests, the quality of the results is related to the quality of the sample collection process.

Several factors may influence the quality of sample collection and increase the chance of sample contamination. These include not collecting enough blood and poor sterility of the collection process. Contamination of blood cultures may result in the patient staying longer in hospital, being prescribed unnecessary antibiotics and increasing the costs of care.

This study will implement a rigorous intervention to reduce contamination rates in blood culture samples collected at the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital. The intervention comprises: education to staff that collect blood cultures; the introduction of blood culture collection kits; and regular feedback of quality indicators to the clinicians that collect blood cultures.

If successful, a reduction in blood culture contamination rates and single sets of cultures should be seen, and the average volume of blood cultured should increase. These outcomes may help to reduce patient length of stay, cost of care, with positive effects in anti-microbial stewardship and patient flow.

Data linkage & patient outcome study: Aeromedical services in Central Queensland

The development of linked data from aeromedical retrieval & health system databases will provide improved, value-added insights to patient care and outcome analysis. This first-of-its-kind study seeks to take the next step in patient-centered outcomes research and resource allocation planning by linking together existing, but independent emergency department, aeromedical, hospital and death databases. Our pilot study has linked databases, creating secure & robust infrastructure for future state-wide studies.

The aims of the study are:
a) Utilise the linked data infrastructure that we’ve created, allowing next phase state-wide replication; describe aeromedical patient outcomes (including length of stay and mortality); understand aeromedical service requirements for specific illness/ injury, those that require frequent flights, & identify steps within the patient journey.
b) Develop a better understanding of the aeromedical patient journey to help to develop appropriate health services delivery, in particular emergency departments whom most often are first point-of-service, thus ensuring better health outcomes.

Is Helicopter Transport Safe for Divers with Decompression Illness?

Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of bubbles and make symptoms worse before divers can access treatment. This study will determine if this is true – will bubbles actually be increased by the vibration associated with helicopter flight? If vibration does increase bubble formation, then in the future alternative strategies for transporting DCI patients can be implemented to reduce the risk to these patients. To ensure safety the vibration record of helicopter flight will be recorded and reproduced using a vibrating basket model. Healthy volunteers accompanying divers in the recompression chamber will be assessed with a special ultrasound to detect bubbles following the ‘dive’ and then placed in the vibrating basket. The number of bubbles present after this will be measured again. This study will help ensure safe transport of injured divers not just in Queensland but internationally. This global importance is represented in the research team, which includes members from both Canada and other Australian states, which are collaborating in a Queensland based study.

Accelerated pathway in the assessment of suspected acute coronary syndrome in the Emergency Department: a diagnostic accuracy study.

Chest pain is one of the most common conditions treated in the Emergency Department (ED), but making a diagnosis remains challenging and resource-intensive. Not all causes of chest pain are due to heart disease. Currently, doctors do a blood test to look for the presence of a cardiac chemical called Troponin I to assist them in making a diagnosis of heart disease. This chemical is released from heart muscles when they are damaged and is, therefore, a good indicator of heart attack. However, because Troponin I is released slowly, doctors have to wait for up to six hours to determine whether it is present in the blood.

This project hopes to make a more rapid diagnosis of the patient’s chest pain by measuring several different heart hormones and chemicals two hours after an individual presents to the ED. These chemicals are known as creatine kinase-MB-isoenzyme (CK-MB), B-type natruiretic peptide (BNP), and myoglobin.

This project will recruit 1000 consecutive patients presenting to the Royal Brisbane Emergency Department with greater than 5 minutes chest pain. Patients will be managed and investigated as per standard care. However, additional blood test will be taken at two hours to assess the combination of heart chemicals. Later there will be follow-up on patients to determine whether the two hour test was accurate in diagnosing heart attack.

Examination of health care assessment practices and costs pre- and post- implementation of an accelerated chest pain assessment protocol.

Professor Cullen and her research team developed the IMPACT protocol with EMF funding. This protocol enables the rapid diagnosis of low and medium risk patients presenting to the emergency department with chest pain. The protocol has been put into practice across Queensland Health. This body of research aimed to identify whether the translation had been successful at the Royal Brisbane and Women's Hospital.

Delivering emergency care in the watch house: an outcomes analysis.

Increasingly, prisoners are requiring transfer to and assessment in the ED; some for illnesses that may be treated in the custodial environment with an appropriately trained health care professional. Optimising how health care is delivered in the watch house environment was the focus of this study, following recommendations in a recent (2012) Inquiry following the death of Herbert John Mitchell.

This study is underpinned by recommendations from deaths in custody, the literature and anecdotal experience. The study will provide a comprehensive outcomes evaluation of a 66 day trial of a model where emergency nurses were posted to the local watch house for an 8hr late shift and a 10hr night shift to supplement domiciliary nursing services to provide 24hr nursing presence in the watch house. This model of enabling experienced emergency nurses the opportunity to work within an 'out of hospital environment' but with the support from medical colleagues has not to our knowledge been trialed elsewhere and is therefore innovative.

The impact expected from this study is on the prisoners, health care staff and police staff working in this model. We expect the following main outcomes: less transfers of prisoners to ED from the watch house and a cost effective model.

Serum catecholamine levels in Irukandji Syndrome (IS)

Irukandji Syndrome (IS) is a condition caused by the venom of jellyfish found in the tropical waters of Australia and has received significant media attention over the past decade. The syndrome most commonly presents with a variable combination of severe generalised pain, involving the torso and limbs, nausea and vomiting, sweating, headache and severely elevated blood pressure and pulse. Documented complications of IS include myocardial (heart) damage and failure, intracerebral haemorrhage (bleeding on the brain) and death.

The signs and symptoms of IS are believed to be due to excessive release of endogenous catecholamines (stress hormones). A number of in-vitro and animal studies have documented elevated adrenaline and noradrenaline levels after exposure to venom from Carukia barnesi and related jellyfish. To date, no human trials have measured serum catecholamines in patients with suspected IS.

This elevation in serum catecholamines may account for the profoundly elevated blood pressure and heart rate seen with IS. However, it is unclear what association the severe generalised pain of IS has with elevation of the endogenous catecholamines, i.e. cause or effect. The research team will conduct a prospective, observational, case-control study on patients with IS at The Townsville Hospital to measure serum levels of noradrenaline and adrenaline.